Diaphragmatic injury. A clinical review.

OBJECTIVE: Recent experience at King Fahad Hospital of the University, Al-Khobar University, Kingdom of Saudi Arabia was reviewed to identify the pitfalls in the diagnosis of diaphragmatic injuries, and attempt to develop a scheme by which early diagnosis is achieved in order to avoid the sequelae of delayed presentations. METHODS: A retrospective chart review of patients admitted to the surgical service, with the diagnosis of diaphragmatic injury was undertaken during the period June 1994 through to June 1999. RESULTS: The total number was 8 patients, and the age ranged between 6-71 years. Of these patients 5 were diagnosed immediately post-traumatic, 2 with delayed presentation, and one with recurrent post-traumatic repair. This case was excluded. Six patients presented following blunt and one after penetrating trauma. Rupture occurred mainly on the left dome of the diaphragm in 5 patients and on the right in 2. Complications ranged from mild chest symptoms to severe respiratory and multi-system involvement. CONCLUSION: Diaphragmatic injuries occurred in 2%-5% of multiple trauma victims. It is considered a predictor of serious associated injuries, However, as many as 10%-30% are missed during the initial evaluation. A high index of suspicion is required, and judicious use of diagnostic aids should be employed to reach early diagnosis to avoid the sequelae of missed injuries.

Immediate discontinuation of intravenous fluids after common surgical procedures.

BACKGROUND: Intravenous (IV) fluids and nasogastric (MG) intubation can be discarded safely in some abdominal operations, but this practice seems rare in our community. SETTING: A University teaching hospital in Eastern Saudi Arabia. AIMS: To determine the feasibility of the practice in our setting and increase clinicians' awareness of it and encourage its general adoption. METHOD: A prospective verification study in consecutive ASA Classes I and II adult patients scheduled for four commonly performed operations. END POINTS: The practice was considered successful if the patient accepted early oral fluids and did not require re-insertion of IV line. RESULTS: The operations studied were appendicectomy (44), laparoscopic cholecystectomy (35), herniorrhaphy (19) and diagnostic laparoscopy (2). The patients' mean age was 34.1 years (range 14 to 68); 60% were males. The overall success rate was 98%. Thus postoperative IV fluids proved to be unnecessary in these patients; cost savings were achieved and treating teams were freed to focus on other patients who truly required IV fluids. CONCLUSIONS: In our setting also, routine IV fluids are unnecessary and can be discarded safely after appendecectomy, cholecystectomy and herniorrhaphy in adults.

Effect of octreotide on the prevention of hyperamylasemia after ERCP in Saudi Arabia: a prospective study.

BACKGROUND AND OBJECTIVES: Acute pancreatitis is a serious complication of ERCP. Octreotide as prophylaxis against ERCP-induced hyperamylasemia has produced conflicting results. A review article has called for additional controlled studies. This work was undertaken to see the effect of octreotide in ERCP-induced enzyme changes in a predominantly Saudi population. SUBJECTS & METHODS: The setting was a university teaching hospital, Eastern Saudi Arabia. The study was prospective, randomized and controlled and the subjects were 50 consecutive adult in-patients. Octreotide, 200 tg subcutaneous, was used in the study group (27 patients). Levels of serum amylase and lipase were estimated three times post-ERCP; mean values were compared with the control group (23 patients) using student t test. RESULTS: A total of 50 patients were studied. Their mean age was 43 (range 19 to 70); 30 were female, a male:female ratio of 1:1.5. The two groups were comparable in terms of age, sex and nationality as well as clinical, haematological and biochemical variables. In both groups, the serum levels of amylase and lipase 4 hours post-ERCP were significantly higher compared with base line levels. However, there were no statistical differences between the mean post-ERCP values within as well as between the two groups of patient studied. However, the pattern of response appeared to be different when amylase was compared with lipase. CONCLUSION: Prophylactic octreotide, in the regimen used in this study, does not protect against post-ERCP hyperamylasemia and hyperlipasemia. The observed apparent difference in the pattern of serum amylase and lipase remains to be confirmed.

Pediatric inguinal hernia: Outcome of repair.

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Injuries due to motorcycle accidents amongst Saudi women. Are we waiting for a new epidemic?

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Abdominal tuberculosis in Saudi Arabia: a clinicopathological study of 65 cases.

The clinical and pathological features of 65 patients with abdominal tuberculosis obtained during a 7-yr period were analyzed and the diagnostic procedures critically evaluated. The diagnosis was histologically confirmed in 59 patients. In two more patients, the diagnosis was based solely on a positive ascitic fluid culture for tubercle bacilli. The remaining four patients responded dramatically to anti-tuberculous chemotherapy given on suspected laparoscopic findings in cases in which no biopsy was taken. Laparoscopy was found to be safer and superior to laparatomy and is recommended as an initial investigation in the diagnostic work-up of patients in whom tuberculous peritonitis is suspected. Furthermore, the finding of granulomatous inflammation in peritoneal biopsy is a justification for immediate therapy in such patients. This is particularly valid in endemic areas if one considers the risks of delaying treatment of these patients.